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Document Verification Request (United States)

This form is to verify documentation for the United States Citizenship and Immigration Services. The form provided here is simply a sample of what the actual Form G-845S looks like.

Department of Homeland Security
U.S. Citizenship and Immigration Services

G-845S, Document Verification Request

Section A-To be completed by the submitting agency.

To: U.S. Citizenship and Immigration Services (USCIS)

___________________________________ From: Typed or Stamped Name and Address of Submitting Agency

Attn: Status Verifier

1. Alien Registration Number or Form I-94 Number ___________________________________

2. Applicant's Name (Last, First, Middle) ___________________________________

3. Nationality ___________________________________

4. Date of Birth (mm/dd/yyyy) ___________________________________

5. U.S. Social Security Number ___________________________________

6. Verification Number ___________________________________

7. Photocopy of Document Attached.
(If printed on both sides, attach a copy of the front and back.)

Other Information Attached (Specify documents). ___________________________________

8. (Benefit)
AFDC ____________________________ (Your Case Number)

Education Grant/Loans/Work study ____________________________ (Your Case Number)

Food Stamp ____________________________ (Your Case Number)

Housing Assistance ____________________________ (Your Case Number)

Medicaid/Medical Assistance ____________________________ (Your Case Number)

Unemployment Insurance ____________________________ (Your Case Number)

Employment Authorization ____________________________ (Your Case Number)

Other (specify) ___________________________________

____________________________ (Your Case Number)

9. Name of Submitting Official ___________________________________

10. Title of Submitting Official ___________________________________

11. Date ___________________________________

12. Telephone Number ___________________________________


Section B-To be completed by USCIS

USCIS RESPONSE: From the documents or information submitted and/or a review of our records we find that:

1. This document appears valid and relates to a Lawful Permanent Resident alien of the United States.

2. This document appears valid and relates to a Conditional Resident alien of the United States.

3. This document appears valid and relates to an alien authorized employment as indicated below:

a. Full-Time
b. Part-Time
c. No Expiration (Indefinite)
d. Expires on: (Specify mm/dd/yyyy below)

___________________________________

4. This document appears valid and relates to an alien who has an application pending for:
(Specify USCIS benefit below)

___________________________________

5. This document relates to an alien having been granted asylum/refugee status in the United States.

6. This document appears valid and relates to an alien paroled into the United States pursuant to Section 212 of the I&N Act.

7. This document appears valid and relates to an alien who is a Cuban/Haitian entrant.

8. This document appears valid and relates to an alien who is a conditional entrant.

9. This document appears valid and relates to an alien who is a nonimmigrant.
(Specify type or class below)

___________________________________

10. This document appears valid and relates to an alien not authorized employment in the United States.

11. Continue to process as legal alien. USCIS is searching indices for further information.

12. This document is not valid because it appears to be: (Check all that apply)

a. ____ Expired
b. ____ Altered
c. ____ Counterfeit

USCIS Stamp

Comments

13. No determination can be made from the information submitted. Please obtain a copy of the original alien registration documentation and resubmit.

14. No determination can be made without seeing both sides of the document submitted. (Please resubmit request.)

15. Copy of document is not readable. (Please resubmit request.)

"PRUCOL"
For Purposes of Determining Only If Alien Is Permanently Residing Under Color of Law!

16. USCIS is actively pursuing the removal of an alien in this class/category.

17. USCIS is not actively pursuing the removal of an alien in this class/category at this time.

18. Other.

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